Provider Demographics
NPI:1275857922
Name:ROBERT ROSSERO MD LLC
Entity Type:Organization
Organization Name:ROBERT ROSSERO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-263-2200
Mailing Address - Street 1:3340 PROVIDENCE DR
Mailing Address - Street 2:SUITE 466
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4627
Mailing Address - Country:US
Mailing Address - Phone:907-263-2200
Mailing Address - Fax:907-276-0366
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:SUITE 466
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4627
Practice Address - Country:US
Practice Address - Phone:907-263-2200
Practice Address - Fax:907-276-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6817207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021335Medicaid
AK162931Medicare PIN